Working with families/whānau - Te Pou · 2015-04-07 · Working with families/whānau – Essential level Learning module – print version 2 Published in September 2009 by Te Pou

Working with families/whānau Essential level learning module

Working with families/whānau – Essential level Learning module – print version

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Published in September 2009 by Te Pou o Te Whakaaro Nui

The National Centre of Mental Health Research, Information and Workforce Development.

PO Box 108-244, Symonds Street, Auckland, New Zealand.

ISBN 978-1-877537-35-6

Web www.tepou.co.nz/letsgetreal

Email [email protected]

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Contents

Introduction .................................................................................................................. 4 1 Recognising families and whānau .................................................................................. 7 2 Working with service users to involve family and whānau ....................................................12 3 Working in partnership with families and whānau .............................................................17 4 Policies of partnership with families and whānau..............................................................22 References and recommended reading .................................................................................26 Learning Review Tool......................................................................................................29 Individual Professional Development Plan .............................................................................31


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Introduction

The Real Skill for working with families/ whānau is:

Every person working in a mental health and addiction treatment service encourages and supports families/whānau to participate in the recovery of service users and ensures that families/whānau, including the children of service users, have access to information, education and support.

Performance indicators – essential

By the end of this module you will be able to:

• recognise that a service user’s family/whānau may extend beyond traditional family concepts

• recognise that Māori have processes that promote and support the establishment of relationships through kinship, genealogy, history and location

• work in partnership with the service user to identify and include family/whānau, significant people and other networks to support recovery

• establish connection and rapport with family/whānau as part of a thorough assessment process and recovery planning

• work with family/whānau in such a way that they feel heard, informed and supported

• share relevant information with family/whānau and significant people while respecting the service user’s right to privacy

• work to understand family/whānau perspectives, including the dynamics within family/whānau

• identify those who can provide support within the community, including hapū and iwi, and connect family/whānau with them

Preparation To help you complete this module, please familiarise yourself with key national strategy and policy documents relevant to your specific area of work (older adult, adult, child and youth, alcohol and other drugs For your reference a list of recommended reading is included in this module. It is strongly recommended that you familiarise yourself with these documents, as they relate to working with families and whānau.

In particular, you should be familiar with the following national strategies, policies and documents.

• Ministry of Health. (2000). Involving Families: Guidance notes. Wellington: Ministry of Health.

• Community Liaison Committee of the Royal Australian and New Zealand College of Psychiatrists. (2002). Involving Families: Guidance Notes: Guidance for Involving Families and Whānau of Mental Health Consumers/Tangata Whai Ora in Care, Assessment and Treatment Processes. Wellington: Royal Australian and NZ College of Psychiatrists & Ministry of Health.

• Mental Health Commission. (2001). Recovery Competencies for New Zealand Mental Health Workers. Wellington: Mental Health Commission.

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See in particular competency number 10 (pp. 70-73): “A competent mental health worker has knowledge of family/whānau perspectives and is able to support their participation in services”.

• Whiteside, R.G. & Steinberg, F.E. (2003). Creating Partnerships: A New Zealand guide to including families in mental health assessment and treatment. Auckland: Phac Publications

• Lumb, T. (2007). Participating in Partnership: Guidelines for enabling effective family whānau participation in CAMH and AOD services in New Zealand. Auckland: The Werry Centre for Child and Adolescent Mental Health Workforce Development.

• Ministry of Health. (2005). Te Tāhuhu: Improving mental health 2005–2015: The second New Zealand mental health and addiction plan. Wellington: Ministry of Health.

• Ministry of Health. (2006). Te Kōkiri: The mental health and addiction action plan 2006–2015. Wellington: Ministry of Health.

There are several main themes included in this module:

• understanding the context of families and whānau

• understanding how to engage with families and whānau, in order to provide support for the them and contribute to recovery

• understanding and connecting families and whānau to community support options and resources

• understanding policies of involvement and participation and the impact of these on your role.

To gain the maximum benefit from this module you are encouraged to think about how the learning module applies to you and your work context. When you have finished working through this module use the Learning Review Tool to help you reflect on how you work with families and whānau. This will enable you to identify where your strengths are, along with any areas you may need to further explore in your Individual Professional Development Plan.

Overview

“Other things may change us but we begin and end with family” – Anthony Brant.

Families and whānau are likely to require support, information, education and consideration at all levels and in all aspects of mental health and addiction services. To achieve this, addressing the needs of families and whānau, working with service users to strengthen their relationships with their families and whānau, and including family and whānau in service delivery and development is important. Informing and working with families, whānau and service users collectively can result in better outcomes for everyone, and doing so is now a requirement of all mental health and addiction services. The Mental Health Commission’s recovery competencies (2001), and the Standards New Zealand Health and Disability Services Standards (2008), Te Kōkiri (2006) and Involving Families (2001) all indicate the need for the participation, involvement, education and support of service users’ family and whānau.


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A powerful vision for the inclusion of families and whānau comes from the Mental Health Advocacy Coalition’s discussion document Destination: Recovery (2008):

“Families and whānau retain hope for their family member. They are supported and educated to enhance the recovery of their family member as well as the recovery of the family unit from the stresses associated with mental distress. Mental health workers welcome their involvement knowing they can be part of the recovery journey”.

This vision characterises the experience of families and whānau as one of being supported and supportive, as opposed to grieving and unsupportive. It emphasises both the ongoing supportive role of families and whānau, and the requirement for families and whānau to be supported. This emphasis is seen in Te Hononga (Mental Health Commission, 2007) where it is advocated that services should promote the well-being of service users and their families and whānau. It is important that families and whānau are supported and educated to enhance recovery and maintain their well-being.

The identification of families and whānau is a highly personalised to the service user. The service user’s perspective, be they a child, youth, adult or older adult, is a critical factor in the process of identifying the members of their family, and in most situations the service users will be the expert. Often the challenge for mental health and addiction service staff will be one of supporting the re-building and reconnecting of families and whānau, rather than simply understanding who the existing members are. This is because the impact of a service user’s mental ill health or addiction can have a dramatic effect on the family. In completing this module you should constantly reflect on how you can include and work with families and whānau, for both their’s and the service user’s benefit.

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1 Recognising families and whānau 1.1 Think about who you consider your family or whānau to be. Think about who you would want around you to support you if you needed some help for a while. Now write your own definition of family or whānau.

1.2 What does your family or whānau look like? Who is in it? Are they all related and in what ways?

1.3 What strengths does your family or whānau collectively have? How are these used to support and assist other family or whānau members?


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How we define and understand families and whānau is often influenced by our own experiences of family and whānau and our culture. It is important to understand that the people we work with will have different experiences, values and perceptions of family and whānau. In our roles, we must always be open to assisting and supporting the service user to:

• define and determine their own meaning of family or whānau

• identify the people they feel have value in their lives

• work with them to strengthen their positive connections with their family or whānau.

Furthermore consideration must be given to the families and whānau in supporting their loved one facing the challenges of mental distress or addiction experiences.

Whānau (kuia, koroua, pakeke, rangatahi and tamariki) is commonly understood to be the foundation of Māori society. As a principal source of strength, support, security and identity, whānau plays a central role in the well-being of most Māori, both individually and collectively. Traditionally each whānau member, (from young children to elders), is valued and plays an integral part in contributing to the well-being of the whānau.

1.4 Please describe below your understanding of Māori concepts of whānau. What are some key considerations for you in your work with tāngata whaiora and their whānau?

1.5 Indicate below the implications for your work in the following whakatauki:

“Whakapuputia te kakano, kia kore e whati.”

“Bind the whānau together, so it stays strong.”

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1.6 Please describe how the terms family and whānau are defined in terms of the current national policy direction. Refer to Te Kōkiri (Ministry of Health, 2006) (in particular the glossary of terms and abbreviations

Family:

Whānau:

1.7 The following words are all used in relation to families and whānau. Some of these are defined for you in different documents relating to working with families and whānau, while others you are likely to hear at different times in your working role. Take a look and, either alone or with a colleague, consider your understanding of the terms used. What do they mean to you? How do you use them in your work? Are they commonly understood in your workplace?

Hapū

Iwi Solo parent Family burden Significant other

Support network

Family structure Family dynamic Blended family Whānau

Nuclear family

Clan Family form Step family Family stress

Dependant

Co-dependent De-facto Partner Fono

Function

Single Jia Sibling Co-habiting

Family of friends

Significant people Aiga Carer Parivaar


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1.8 For any of the terms above that you are unfamiliar with, research it and then write a description below.

1.9 List some of the other terms you use in your work to describe family systems and structures.

1.10 What are some of the negative or stereotyped views of family and whānau that you have encountered in your workplace?

1.11 Indicate below what your response is (or would be) when you encounter negative stereotypes.

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1.12 What are some of the positive views and expressions of the value of family and whānau that you encounter in your workplace?

1.13 In the table below, please identify challenges you face when working with service users to involve and include families and whānau. For each challenge please identify potential solutions.

Challenges Solutions


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2 Working with service users to involve family and whānau

2.1 Read the following story of Wiremu, a young Māori male living in the community following a recent brief stay in prison and answer the questions that follow:

Wiremu’s story Wiremu is 31 years old and is the second oldest of five in his whānau. He has used both mental health and addiction services for the past 12 years following his first experience of mental illness as a 19 year old. In the past, when things were really challenging for Wiremu and his drug use was harmful, he got caught up in prospecting for a gang. Wiremu indicates that a lot of the things that contributed to his prison sentence were because of drug debts. He indicates that he now wants to get away from that lifestyle, control his substance use, strengthen his connections with his whānau and get a job. Wiremu believes that he has “freaked out” his family, as they have very little contact with him. He believes that he probably burnt his bridges sometime ago now, as he had previously done some pretty dodgy things. He has indicated that he would like the opportunity to “right some wrongs”, but states that he is unsure if they know what goes on for him. He states he has never spoken about his mental illness or drug addiction with any of them and neither, to his knowledge, have any of the staff of services that he has used. Wiremu is the father of two young children whom he visits on a planned basis. He states that he would like to have more to do with raising his children and would like to be better able to financially support them. Being a better role model and father is a clearly a significant goal for Wiremu and an apparent reason for him wanting to get his “life back together again”. Wiremu has a brother who visits him occasionally and who has indicated that he wants to be involved in helping Wiremu get back on his feet again. He is just unsure about what to do or how to start, and is anxious not to do anything to place extra stress on Wiremu.

2.2 Thinking about the issues for Wiremu in relating to his whānau, develop a strategy for working with Wiremu to achieve his goal of stronger connections with his whānau.

In the table below, identify the issue and then indicate the strategy you would use to address the issue. The first issue is completed for you, although you may identify other strategies for addressing this issue.

Issue Strategy

Building on and growing Wiremu’s relationship with his brother.

Support Wiremu to explain to his brother what he needs from him. Provide education and information to Wiremu’s brother about mental illness, drug addiction, medication and recovery. Encouraging Wiremu to share his thoughts with his brother about the visits and what they mean to him. Demonstrate ways in which his brother can support Wiremu that will promote his self-belief in his own recovery.

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2.3 Wiremu and his brother have decided to hold a whānau hui to reconnect and they have requested your participation. Please describe in the table below how would initiate contact with the whānau? How would you find out what the needs and perspectives of the whānau members are?


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2.4 Supporting families and whānau often requires actively assisting family and whānau members to access local community resources. There are some services that are specifically funded to provide family and whānau support, and there are also a diverse range of community-based social and health services that can be accessed (often with little cost to the family or whānau).

Please describe below the processes that your service has in place to support family and whānau members.

2.5 In the section below think about and identify sources of support for families and whānau within the community that you work in.

List the types of support needed by families/whānau along with the community service or resource you can assist them to access.

Type of support:

Service or community resource to access:

Type of support:


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Type of support:


Type of support:


Type of support:


2.6 Read the following extract by a family or whānau member who was excluded from the communication and support planning for their elderly parent.

By them allowing Dad to come home without really finding out if we were ready or even able to have him come back home was so frustrating. I know that we made the decision to have him stay with us and not be put in a home, but it seems that everyone assumes that our ability to cope continues regardless of how he is or what’s happening for us. Having him go into the hospital was the hardest thing I ever did. I felt so guilty! Yet having him come back without any information or support is even harder. Even Dad’s attitude toward us has changed. I was so upset and angry because it’s not just me that it affects, but the rest of the family also. I suppose all we can do is keep trying to cope!


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2.7 What do you think could have been done differently in this situation to prevent the person from feeling “so upset and angry” about the care of their parent?

2.8 Please list the types of supports and community resources that are available in your community to help this family member look after their elderly father?

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3 Working in partnership with families and whānau

“People with serious mental illness are not ill in isolation. Their families, extended whānau, and significant others, whatever they think about the illness, can not escape being affected by it” Health and Disability Sector Standards (Mental Health Commission, 1998, p.9).

In New Zealand in 2004 Bridgman and Tollestrup (2004) interviewed a small number of people who used Supporting Families support groups. Participants raised a number of issues that they experienced when working with mental health services. The most common issues raised were:

• difficulty in obtaining information about their loved one

• poor communication by services to the family

• lack of respect

• problems with diagnosis, medications or treatments

• the family voice and perspective being ignored.

A larger study in England (Repper, Grant, Nolan and Enderby, 2008) reflects very similar findings.

Carers (the term the study used for family) wanted the following:

• to be listened to, have their knowledge and expertise valued, and be treated as partners

• services that were proactive, dependable, consistent, responsive, and family or community oriented

• respect for their personal values and cultural beliefs

• to be provided with hope and positive ways of coping with the experiences of a loved one.

3.1 The following exercise is designed to help you understand the importance of working in partnership with families and whānau. If you have a family or whānau member who uses mental health or addiction services, answer the question in relation to that person. If not, imagine a loved family or whānau member has developed a mental health or addiction issue and is now receiving mental health or addiction services. It may be a child, an adult or an older person.

3.2 What are your feelings and concerns for your loved one?

3.3 How do you want to be treated by the mental health and addiction service staff?


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3.4 What involvement do you want to have in your family/whānau members recovery planning and decision making?

3.5 How would you feel if you were excluded from the delivery of care to your family or whānau member?

Family and whānau members often comment that they “know” their family or whānau member particularly well. They have awareness and information, which they believe would be extremely helpful and beneficial for mental health or addiction services to know. They want to contribute to the recovery of service users. Working in partnership with families and whānau is therefore viewed as an important competency for all people working in mental health and addiction services.

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3.6 Quickly brainstorm and list all of the skills, knowledge and values you have that enable you to effectively engage and work with families and whānau.

Skills and knowledge Values

3.7 Briefly outline a situation that you have been involved in where both the service user and the family or whānau member(s) indicated happiness with an outcome. What did you do to contribute to that outcome?

3.8 Briefly outline a situation where either the service user or a family or whānau member was not happy with the outcome. What would you do differently to improve the experience for the service user and for the family or whānau member?


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3.9 Which of the Let’s get real values are reflected in your responses to the above? Indicate how they are reflected.

The Let’s get real values and attitudes provide a strong foundation for the values that people should hold when working in partnerships with families and whānau. These are:

• respect

• rights

• service

• recovery

• communities

• relationships.

These values all apply when engaging with family and whānau. Upholding these values often requires affirming them when we come across comments or behaviours from colleagues that are contrary to them. The next exercise will help you determine how you could assert these values when they are being challenged in relation to working with families or whānau.

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3.10 Record how you would challenge the following comments, which have been made to you by a colleague. You may find Involving Families: Guidance notes (Ministry of Health, 2001) and Participating in Partnership (Werry Centre for Child and Adolescent Mental Health Workforce Development, 2007) helpful resources.

Comment Your response “I am far too busy to be involving families.”

“Family involvement is just a lot of PC nonsense.”

“Working with this family simply won’t lead to a positive outcome.”

“The Privacy Act stops me from working with families.”

“A relationship with this family confuses my therapeutic relationship with the service user.”

“It is not part of my job.”

“This family are the cause of all the service user’s problems.”


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4 Policies of partnership with families and whānau

It is current national policy that families and whānau should be included in processes that service users are involved in, such as developing recovery plans, assessment and treatment, and service planning, delivery, and evaluation (Te Kōkiri, 2006). It is also policy that services should recognise and respond to the needs of families and whānau, including providing support, education, information and feedback (Te Kōkiri, 2006).

Your organisation should have an internal policy that relates to working with and involving families and whānau. Find this policy document and respond to the following questions.

4.1 What are the suggested organisation processes you should follow to include families and whānau?

4.2 How does your organisation show evidence of its family and whānau inclusive practices?

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4.3 Please list the considerations that you have to take into account when it comes to sharing relevant information with families and whānau? Describe how do you balance the needs and wishes of the service user, with those of their family or whānau?

4.4 Given your learning to date in this module, what suggested changes would you make to your organisation’s policies of partnership with families and whānau?

4.5 To complete the next activity you need to source a copy of Involving Families: Guidance notes (Ministry of Health, 2000). You will find the document on the ministry’s website, www.moh.govt.nz (search for the term Involving Families).

Partnerships between families and whānau, service users and mental health staff are seen as a dynamic process with four main aspects. These are illustrated in the diagram below.


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4.7 Using the practical suggestions outlined on pages 7 to 12 of Involving Families, record two things that you are currently doing that reflect family or whānau involvement and participation, and list a further two things that you can start doing.

The process of involvement What I currently do What I will start to do

Defining the partnership

Providing information, education and support

Planning and preparing for the future

Reviewing at critical points


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References and recommended reading Bridgman, G., & Tollestrup, D. (2004). What happens in supporting groups? Interviews with participants and facilitators. 25th Anniversary Celebration of Supporting Families in Mental Illness, 26 August, Auckland, New Zealand.

Families Commission. (2008). The Kiwi Nest: 60 years of change in New Zealand Families. Wellington: Families Commission.

Lakeman, R. (2008). Family and carer participation in mental health care: Perspectives of consumers and carers in hospital and home care settings. Journal of Psychiatric and Mental Health Nursing, 15, 203–211.

Lumb, T. (2007). Participating in Partnership: Guidelines for enabling effective family whānau participation in CAMH and AOD services in New Zealand. Auckland: The Werry Centre for Child and Adolescent Mental Health Workforce Development.

Mental Health Advocacy Coalition. (2008). Destination: Recovery: Te ungaki uta: Te oranga. Auckland: Mental Health Foundation.

Mental Health Commission. (1998). Blueprint for Mental Health services in New Zealand: How things need to be. Wellington Mental Health Commission.

Mental Health Commission. (1999). Protecting Your Health Information: A Guide to privacy issues for users of mental health services. Wellington: Mental Health Commission.

Mental Health Commission. (2001). Recovery Competencies for New Zealand Mental Health Workers. Wellington: Mental Health Commission.

Mental Health Commission. (2002). Review of the Implementation of the Privacy Act 1993 and the Health Information Privacy Code 1994 by District Health Boards’ Mental Health Services. Wellington: Mental Health Commission.

Mental Health Commission. (2007). Te Hononga: A picture of mental health and addiction services in 2015. Wellington: Mental Health Commission.

Metge, J. (1995). New Growth from Old: The whānau in the modern world. Wellington: Victoria University Press.

Ministry of Health. (2000). Involving Families: Guidance notes. Wellington: Ministry of Health.

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Ministry of Health. (2005). Te Tāhuhu: Improving mental health 2005–2015: The second New Zealand mental health and addiction plan. Wellington: Ministry of Health.

Ministry of Health. (2006). Te Kōkiri: The mental health and addiction action plan 2006–2015. Wellington: Ministry of Health.

Ministry of Social Development. (2008). Caring for the Carers – He Atawhai I te Hunga Ngakau Oha o Aotearoa: The New Zealand carers’ strategy and five-year action plan. Wellington: Ministry of Social Development

Repper, J., Grant, G., Nolan, M., & Enderby, P. (2008). Carers’ experiences of mental health services and views about assessments: Lessons from the Partnership in Carer Assessments Project. In Stickley, T., & Basset, T. (Eds), Learning About Mental Health Practice. London: John Wiley & Sons Ltd. (pp 419-437).

Royal Australian and New Zealand College of Psychiatrists. (2000). Involving Families: Guidance notes. Wellington: Ministry of Health.

Standards New Zealand. (2008). Health and Disability Services (General) Standard: NZS 8134.0.2008. Wellington: Standards New Zealand.

Walker, T. (2006). Whānau is Whānau. Wellington: The Families Commission.

Whiteside, R.G. & Steinberg, F.E. (2003). Creating Partnerships: A New Zealand guide to including families in mental health assessment and treatment. Auckland: Phac Publications.

Working with families/whānau – essential level Learning Review Tool and Individual Professional Development Plan

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Learning Review Tool Using the Likert scales below, rate your work in relation to working with families and whānau.

I have a good understanding of why it is necessary to involve families and whānau and can identify strategies for working with families and whānau in my role.

1 2 3 4 5

Not so much Absolutely

I can identify strategies for working with service users to involve and include families and whānau.

1 2 3 4 5

Not so clearly Absolutely

I can identify and discuss the policy documents about family and whānau inclusion.

1 2 3 4 5

Not so confident Absolutely

I understand and can explain the key values and attitudes and my role in working with families and whānau.

1 2 3 4 5

Not so clearly Absolutely

Choose your response to one of the above statements, and explain why you made this response.


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What new knowledge or insights have I gained from working through this module?

What are three things I can put into practice or improve upon as a result?

A

B

C

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Individual Professional Development Plan Working with families/whānau (essential level)

One thing I can take personal responsibility for.

Action

What will I do?

Timeframe

When will I do this?

Resources

What or who will I need?

Challenges

What barriers or resistance will I face?


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One thing I can advocate for and work towards.

Action

What will I do?

Timeframe

When will I do this?

Resources

What or who will I need?

Challenges

What barriers or resistance will I face?

Please retain this Individual Professional Development Plan: working with service users (essential level) to contribute to your summary action plan once you have completed all of the learning modules.

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Documents

Working with families/whānau - Te Pou · 2015-04-07 · Working with families/whānau – Essential level Learning module – print version 2 Published in September 2009 by Te Pou